FACE-OFF WITH A
SURGING CONDITION

Facial symmetry restored in a 64-year-old patient
with a gradually progressive left facial swelling

A 64-year old man with painless left facial swelling, which was gradually progressing for the past one year, was brought to Nanavati Super Speciality Hospital. The swelling was causing fluid discharge and redness in the left eye since the last 2 months and was also slowly developing double vision. On examination, there was a diffused bony swelling under the left cheek approx 10cmx 10cm in size, hard, fixed, nontender, with normal overlying skin. Intraorally there was a bulge of the hard palate, occupying a large area of the oral cavity.

A CECT (Contrast Enhanced Computed Tomography) scan of the paranasal sinuses and neck showed a well defined lobulated soft tissue 10x8x6cm sized lesion. The lesion was seen arising from the ethmoid sinus medial wall with erosion, intraorbital extension, extending into the caudal aspect of the left infratemporal fossa, left retromolar trigone, involving the left masseter muscle, left temporalis muscle, flushed with the left medial rectus muscle, left zygomatic bone and left maxillary annulus.

CT guided Tru-cut biopsy from the left cheek swelling showed Benign Fibroosseous Lesion, suggestive of Cementoossifying Fibroma.

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"These are slow growing tumours and if neglected may lead to facial asymmetry due to cortical expansion. Complete and thorough surgical removal at the earliest is advised, and 10 years follow-up is required." 1
The patient was planned for a left maxillectomy with reconstruction. A stony hard mass of 10cm x 8cm x 6cm size was removed en bloc and reconstruction was done with microvascular anterolateral thigh flap transfer. The post-operative period was uneventful, and the patient was discharged within a week with all vitals under normal limits. He was taking food orally and was well mobilised. HPE report showed Cemento- ossifying fibroma.

Cemento-ossifying Fibroma is a relatively rare non-odontogenic Tumour of jaws. Cememto-ossifying Fibroma now called as Ossifying Fibroma are odontogenic which originates from the periodontal ligament or from an ectopic periodontal membrane in the frontal, temporal, sphenoid and ethmoid bones. These are slow growing Tumours and if neglected may lead to facial asymmetry due to cortical expansion. Complete and thorough surgical removal at the earliest is advised and 10 years follow-up is required. Large Tumour of the facial skeleton can be severely debilitating for form and function in term of cosmetic deformity and difficulty in speech and swallowing.

Dr. Sudeep Sarkar

Dr. Sudeep Sarkar
Sr. Consultant
Surgical Oncology
Nanavati Super
Speciality Hospital
Mumbai

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